Virtual Event Request

1

Virtual event fees are typically billed at $500 for a virtual presentation. Would you like to proceed?* This field is required.

YesNo

2

Is this your group's first time to request a WallBuilders Speaker?* This field is required.

YESNO

3

Type of Event* This field is required.

4

Your Speaker Preference* This field is required.Who would be your first choice for a speaker?

Tim Barton

David Barton

5

If your preferred speaker is not available, would you like us to transfer your request to another of WallBuilders' speakers?

YesNo

6

Event sponsor agrees to pay the event fee by the due date given in the contract. WallBuilder Presentations reserves the right to cancel participation if payment is not received by the requested date.* This field is required.

I acceptI don’t accept

7

The Speaker's presentation may not be recorded or distributed unless prior permission has been secured from WallBuilder Presentations.* This field is required.

I acceptI don’t accept

8

Media Platform Used* This field is required.

9

Event Date* This field is required.

mm-dd-yyyy

10

Event Start Time* This field is required.

11

Speaker's Involvement* This field is required.Please tell us how long you want the speaker to speak and what you expect the speaker to do - just present, leave time for questions, etc.

12

Other ParticipantsPlease list any VIP's or Individuals the speaker might want to know will be present at your event

13

Expected Virtual Attendance* This field is required.

14

Description of Audience* This field is required.

15

Deadline to Receive an AnswerRequest cancellation deadline if no response has been received.

Date

16

CommentsAnything else we should know?

17

Organization or Show/Program Name* This field is required.

18

Organization or Show Website* This field is required.

19

Is this a Church or Ministry?* This field is required.

YESNO

20

Host/Interviewer Name* This field is required.

Title or Prefix

First Name

Last Name

21

Your Name* This field is required.

Title or Prefix

First Name

Last Name

22

Are you a Pastor?* This field is required.

PastorNot a Pastor

23

Your Phone Number* This field is required.

Please enter a valid phone number

24

Your Email* This field is required.

example@example.com

25

Would you like to receive email updates and newsletters from WallBuilders?

YesNo

26

AddressPlease provide us with your address if you would like to know when a speaker is in your areas.

Street Address

City

State / Province

Postal / Zip Code

Country

27

How did you hear about WallBuilders?* This field is required.

28

Name of Audio/Visual Coordinator* This field is required.

29

A/V Contact Phone Number* This field is required.

Please enter a valid phone number

30

A/V Email* This field is required.

example@example.com

31

Data Source

Events

32

Thank you for your interest in a virtual event!

You must agree to all terms and conditions to submit this form. If you would still like to schedule a virtual event, please click the "Previous" button below and agree to the term to continue this scheduling process. We appreciate your understanding!